Interventional cardiology

Women disadvantaged in cardiac care for ACS and CAD


Women with acute coronary syndromes and coronary artery disease receive less evidence-based treatment than their male counterparts, researchers from the NSW have shown.

Their study, which reviewed 7,783 non-ST-elevation acute coronary syndrome (NSTEACS) patients (31% female) across 43 hospitals, showed women were less likely to undergo cardiac catheterisation than men (71% v 77%), and the median time to catheterisation was longer (53 h  v 47 h) than for men.

“At discharge, fewer women were prescribed aspirin (85% v 91%), a second antiplatelet medication (59% v 68%), beta-blockers (71% v 75%), or statins (86% v 92%), or referred to cardiac rehabilitation (54% v 63%),” wrote Dr Bianca Bachelet and Professor David Brieger of Sydney University in The Medical Journal of Australia.

Similar trends were seen for female coronary artery disease patients, who received less coronary artery bypass grafting than men ( 10% vs 16%). They were also less likely to have aspirin prescription at discharge and fewer women than men were referred to cardiac rehabilitation (69%  vs 75%), including of those who had been revascularised.

Despite receiving less evidence-based care, adjusted in-hospital and six-month mortality and major adverse cardiac event rates were similar between men and women.

Women’s higher propensity for non-obstructive coronary artery disease (NOCAD) could partly explain the sex differences in treatment offerings, but “NOCAD is not a benign condition, and patients can benefit from secondary prevention therapies”, Professor Brieger and colleagues suggested.

“In Australia, adherence to guideline-based therapy for people with NSTEACS could be improved, especially for women in hospital and for both sexes at discharge,” they concluded.

Previously the limbic reported on women’s limited access to evidence-based PCI treatment, despite having a potential long-term survival advantage over men.

A study in The American Journal of Cardiology found women were “underrepresented in the PCI population” and, contrary to Australian guidelines, more likely to have femoral artery access over radial access, which can increase major bleeding risk.

Study co-author, Austin Health cardiologist, Dr Alexandra Murphy told the limbic that pharmacotherapy and interventional treatments equally benefited men and women, and there was “no sex discriminant that would give reasoning behind withholding these treatments from women”.

Therefore, women should get equal, guideline-based care as a public health priority, she said.

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